MedAxiom: Service lines, savings proliferating

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 - Green Idea

The use of cardiovascular service line organizations to align resources needed to best serve patients appears to be spreading to all types of healthcare entities, according to MedAxiom’s “2013 Annual Integration Report.” Many reported annual savings between $500,000 and $5 million.

“The re-emergence of the service line, with an incumbent mandate to drive care coordination and value to patients, is a model that has early promise to facilitate effective healthcare transformation,” the report authors wrote. “The service line successful operation, like all operations, is dependent on the leadership and staff that work within it.”

The report was based on an online survey of 156 organizations that represented 2,420 cardiologists that was sent in August 2012.

When asked about their post-integration service line governance structure, 68 percent identified it as a dyad leadership model with physician and administrative co-leaders, a model that MedAxiom described as “rapidly earning best practice status.”  

Forty-four percent of respondents said their management structure was one in which physician and administrative leaders shared responsibility for all cardiovascular services within multiple hospitals in a hospital system. In addition, 22 percent cited joint responsibility for all cardiovascular services in one hospital and 19 percent said there was joint responsibility for some cardiovascular services and departments within a hospital. Only 14 percent responded that physicians delegated responsibility for some or all cardiovascular services.

Cardiology topped the list as the most common clinical participant in the service line, at 88 percent, followed by cardiothoracic surgery at 62 percent and vascular surgery at 42 percent.

The vast majority of respondents said their hospital was a not-for-profit organization, with most in a system that included two or more hospitals. Almost 30 percent reported having between 11 and 20 physicians, and about 5 percent had more than 75 physicians. More than 30 percent were community hospitals, but other types represented were tertiary, teaching, specialty, a health system, rural and public hospitals.

More than half reported participating in accountable care organizations (ACOs), with others involved in payment models such as bundled payments and patient-centered medical homes. Almost half of survey respondents claimed annual savings of more than $500,000 and about 30 percent saw savings between $500,000 and $1 million. Nearly 20 percent reported savings between $1 million and $2 million and about 18 percent placed annual savings between $2 million and $5 million.  

“Many of the programs are participating in innovative payment model pilots, such as ACOs and bundled payments, initiatives that would have previously been embroiled in negotiating the contract terms between the entities rather than focusing on the development of the model,” the authors wrote. “Most programs have been able to standardize equipment and supply utilization and thus effect per unit cost savings and many have begun the work of improving processes within the hospital and practice, but very importantly—between the environments.”

In other findings, respondents said the service line’s primary initiative was:

  • Increasing quality, 79 percent;
  • Clinical program development, 67 percent;
  • Market development and expansion, 63 percent;
  • Reducing costs, 63 percent;
  • Operations efficiency, 54 percent;
  • Reducing risk, 8 percent; and
  • IT optimization, 8 percent.

MedAxiom is scheduled to present survey results Jan. 10 at the American College of Cardiology’s Cardiovascular Summit in Las Vegas.

For more of service line trends, please read "Service Lines: Getting It Straight Under Reform” in the winter issue of Cardiovascular Business.